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0SOCIO-PSYCHOLOGICAL AND ENVIRONMENTAL DETERMINANTS OF MALE INFERTILITY
1Abdullaeva Vasila Karimbekovna, 2Aliev Burkhon Arturovich
1TashPMI professor 2TashPMI assistant https://doi.org/10.5281/zenodo.11372370
Abstract. Men from infertile couples were found to have a high frequency of alcohol consumption with a predominant use of beer or strong alcohol. The frequency of occurrence of these riskfactors does not significantly differ from those in the general population, which indicates the need to strengthen preventive work to reduce the frequency of alcohol consumption as a risk factor for infertility, especially among men of reproductive age. Respondents are more likely to manifest neurotic depression, which in turn can manifest itself in asthenic, phobic and anxious states.
Key words: male infertility, socio-psychological problems, environmental risk factors, psychoemotional characteristics.
The problem of the influence of various environmental factors on the state of human mental health is relevant for psychiatrists and medical psychologists of the 21st century [1]. The negative impact of the polluted environment on the mental state of a person was proved in the course of international studies: when examining the population in ecologically unfavorable regions, in extreme situations, in areas of natural and man-made disasters. Scientists from England have proved the theory that polluted air has a detrimental effect on the psyche of people. It is noted that even a small increase in the amount of harmful substances in the air can cause depression and anxiety in people [14]. One of the most important and widely discussed problems of modern society is the protection of reproductive health of the population. Reproductive problems in marriage, including male infertility, are an important component of demographic processes, the solution of which is one of the unrealized reserves of increasing the birth rate, which is of great socio-economic importance. In recent years, male reproductive dysfunction has become of particular medical and social importance, as the male factor of infertility in marriage is 30-50 %. Particular relevance is the study of the state of reproductive health of men [2, 4]. According to WHO data, the problem of infertility is one of the most urgent medical, social and psychological problems in modern society, which is caused by a combination of social, mental ill-being and, almost always, physical ill-health and psychological stress in the family [1, 6]. Men with infertility are doomed to long and unpromising courses of chaotic empirical therapy, which does not solve the problem at its root, but it also significantly delays the duration of the period of infertility, which is one of the key prognostic factors of infertile marriage. Currently detected clinical abnormalities are highly likely to indicate a common etiological factor - prenatal exposure to substances with estrogen-like or androgenic effects, the source of which is the environment [3]. The reproductive system is one of the most sensitive systems of the body that reacts to environmental pollution, which is characterized by a long duration and low intensity of exposure to adverse environmental factors. factors. Regardless of their nature, they cause similar disorders in the normal functioning of the male and female reproductive systems. The nature of the reproductive system's response to the presence of various chemical and physical factors as environmental pollutants is not specific. This indicates a violation of the mechanisms of central regulation of reproductive function under the influence of unfavorable environmental factors, regardless of their nature [5]. Contact with
toxic substances leads to a violation of spermatogenesis and the development of secretory azoospermia. Dividing spermatogonia in animals and humans they are most sensitive to cytotoxic agents. Reserve spermatogonia are also sensitive to this kind of influence. Idiopathic infertility in men combines all those forms that are associated with a violation of spermatogenesis and with sexual disorders that occur in the form of pathological forms in the hypothalamus-pituitary-testicles system [13]. In the prenatal period, testicular abnormalities are more often caused by physical, chemical, and hormonal factors during the prenatal period. Currently detected similar clinical abnormalities are highly likely to indicate a common etiological factor [12]. Inhibition of spermatogenic function can be promoted by heavy metal compounds, neurotropic poisons that have a toxic effect on spermatogenic cells, hypothalamus, pituitary gland and disrupt feedback mechanisms in the hypothalamic-pituitary-testicular system [10]. This list should also include a wide range of pharmacological medications - sedatives and antidepressants, certain antibiotics, diuretics, lipid-lowering agents, hormones, GnoKaTopw and histamine receptor blockers. It is known that excessive alcohol consumption significantly worsens the parameters of the ejaculate and disrupts the hypothalamic-pituitary-testicular axis Parameters of human seminal fluid are valuable indicators of toxic and possibly genotoxic effects of occupational and environmental factors [11]. At the same time, the mental state of patients and, to a greater extent, their psychological and psychoemotional characteristics have a great influence on fertility and, accordingly, on the outcome of infertility treatment [8]. Numerous studies prove that anthropogenic environmental pollution has a pronounced impact on the formation of population health of the population: the lifestyle of a modern person, the peculiarities of his environment lead to the development of chronic nonspecific intoxication, which has a negative impact on all body functions, including reproductive [7; 9]. Thus, male infertility remains one of the most intractable problems in modern medicine.
The aim of the study was to analyze socio-psychological and environmental risk factors for male infertility.
Material and methods of research. The results of a survey of 72 men aged 26 to 45 years with impaired fertility (the main group) were analyzed. The men underwent a special urological examination. Verification of the diagnosis was carried out on the basis of complaints, medical history and examination, clinical and instrumental research methods. The control group consisted of 20 practically healthy men who were married and had children. When forming a sample group, the principle of voluntary participation in the study was implemented, which made it possible to reduce the possibility of motivational distortions. Participants were guaranteed confidentiality of the results. During the briefing, the study participants were informed that they would be presented with a series of questionnaires. Thus, the instruction and procedure for collecting empirical data assumed leveling the influence of factors that could potentially lead to a decrease in the level of reliability of responses. The following psychometric methods were used: the Spielberger-Hanin Personal and Situational Anxiety Questionnaire; the Hospital Anxiety and Depression Scale (HADS); and the Emotional Tone Assessment Scale. Mathematical data processing was carried out by methods of variational statistics using standard mathematical packages of application programs on a personal computer with the determination of the average, its error, tand the Student's t criterion. To detect differences between the two groups of respondents, the data were checked for the normality of the distribution using the Kolmogorov-Smirnov test.
Results and discussion. In the course of studying the mutual influence of environmental factorsand the probability of infertility development, we paid attention to the nature of complaints
associated with the psychoemotional state of the surveyed men. Most of the men in the main group (95.0%) examined by us at the initial stage of examination and treatment had a short temper, irritability, conflict, sleep disorders, and reduced ability to work. At the same time, the frequency and severity of psychoemotional reactions in the examined men directly depended on the duration of infertility treatment, its pathogenetic forms, as well as the characteristics of a man's somatic health and social status. According to our analysis, we can state that there are statistically significant differences in the level of situational anxiety among respondents with psychological infertility and respondents who have children. The result was obtained at a high level of statistical significance (t=3,665; p<0.01). Thus, men in the main group have a higher level of situational anxiety than those in the control group. Situational anxiety manifests itself in a specific situation related to the assessment of the complexity and significance of the activity, as well as the actual and expected assessment. Situational anxiety is characterized by subjectively experienced emotions: tension, anxiety, preoccupation, nervousness. Situational anxiety characterizes the state of the individual specifically at the present time, which is characterized by tension, anxiety, concern, nervousness in this particular situation. This condition occurs as an emotional reaction to an extreme or stressful situation, can be different in intensity and dynamic over time. The anxiety and restlessness that is manifested in the surveyed main group is explained by a constant feeling of tension and excitement, constant repeated attempts at fertilization, cause a feeling of constant monthly anxiety in a woman. Awareness of your own childlessness, social inferiority is in itself a powerful stress and is accompanied by increased anxiety. Being under constant stress can lead to neurotic emotional reactions to external situational stimuli. Also, according to the results of the study, it was found that the respondents from the control group had a lower level of personal anxiety than the respondents from the main group (t=2,826; p<0.01). So, we can say that men of the main group are more likely to experience anxiety regardless of situational external factors. Personal anxiety is characterized by a state of unaccountable fear, an indefinite sense of threat, and a willingness to perceive any event as unfavorable and dangerous. A person affected by this condition is constantly in a wary and depressed mood, which can be associated with constant fear and excessive excitement about the situation of infertility in the family. The study also showed that the main group had a higher level of depression than the control group (t=3,406; p<0.01).
A special group of patients consisted of men whose sperm pathology is related to the peculiarities of their professional activity, i.e., by the nature of their activity, they were constantly in contact with spermotoxic factors. Among the harmful exogenous factors 25 (34.7 %) men worked in conditions of high ambient temperature у 25 (34,7 %) мужчин, and 10 (13.9 %) -vibration. Work experience from 3.5 to 9 years. Semen pathology consisted of asthenospermia and oligoasthenospermia of the examined patients.
To analyze social factors (use of surfactants), patients underwent a more detailed questionnaire that included questions about smoking history, the number of cigarettes smoked per day, the type and volume of alcoholic beverages consumed, and the type and amount of surfactants consumed. For them, the experience of infertility was 3 (2-6) years, the age of men and their partners was 33 (31-37) and 32 (29-35) years, respectively. 47.9 % consumed beer, 25.6 % - strong alcohol, 14.7 % - beer and / or strong alcohol, 7.6 % - champagne/wine, 2.4 % - beer and/or champagne/wine, 0.5 % - strong alcohol and/or wine/champagne, 0.5 % - strong alcohol and/or wine/ champagne and / or beer, 0.9 % reported binge drinking - repeated consumption of different types of alcoholic beverages for two consecutive days or more, at least 1 episode in 2-3 months. Among smokers, the smoking experience was 15 (10-20) years (from 1 year to 35 years), the
number of cigarettes per day was 15 (10-20) pieces (from 2 to 50). Cigarettes were smoked by 92.7 %, e - cigarettes (aikos, etc.) - 7.3%. In those who consumed strong alcohol, the experience of infertility was 3 (2-5) years, the age of men and their partners was 34 (31-39) and 33 (29-37) years, respectively, in those examined without taking into account bad habits, the corresponding indicators were 3 (2-5), 34 (30-37) and 32 (28-35) years. The volume of strong alcohol consumed was 250 (100-500) ml per week, the minimum and maximum amounts were 50 and 1000 ml per week, respectively.
Further, we analyzed the differences in the methodology for assessing neurotic states. According to the results obtained, the group of respondents who have a diagnosis of psychological infertility is more prone to anxiety (since according to the methodology, the lower the value, the greater the tendency to the painful nature of disorders). The result was obtained at a high level of statistical significance (t=-2.476; p<0.01). It can be assumed that couples who do not have children and do not manage to conceive experience an increased level of anxiety, as they are constantly in a state of tension and stress, which they experience based on the current situation. Also, according to the results of our study, the respondents of the main group have more symptoms of neurotic anxiety than the respondents of the control group (t= -2.642; p<0.01).
When studying the "asthenia" factor, we found that the respondents of the main group are more likely to show asthenic weakness and fatigue, which cannot be said about the group of respondents who have children. These results were also obtained at a high level of statistical significance (t= -1.807; p<0.05). Symptoms of asthenia in the examined main group are high fatigue, attention exhaustion is also characteristic, while lability of emotions with instability and significant mood swings are observed. Asthenic people in situations of unsuccessful attempts to conceive often have a weakened self-control, they are impatient and often irritated due to the current situation and lack of understanding of its causes.
We also conducted a study of differences on the "hysterical form of response" scale between two groups of respondents. Statistically significant differences were found (t= -2.157; p<0.01) and we can say that men of the main group are prone to a hysterical form of reaction, in contrast to people who have children. The same applies to phobic and vegetative disorders, according to statistical analysis, statistically significant differences were found (t= -2.981 and -2.657, respectively; p<0.01) on the "phobic disorders" and "vegetative disorders" scales. This means that men who have children are less likely to have vegetative and phobic disorders, which is not the case for respondents with psychological infertility. The surveyed men of the main group were characterized by infantile behavior, concentration on super-valuable ideas, intolerance to failures with the accumulation of negative emotions, the presence of intrapersonal conflict in the system of self-image, which indicates the presence of a relationship between various emotional and personal factors.
Conclusion. In the gradation of factors affecting the reproductive health of men and causing the formation of pathogenetically significant reprotoxic effects (in particular, idiopathic male infertility), the leading share falls on social and hygienic factors-working conditions, the presence of harmful addictions. Men from infertile couples were found to have a high frequency of alcohol consumption with a predominant use of beer or strong alcohol. The frequency of occurrence of these risk factors does not significantly differ from those in the general population, which indicates the need to strengthen preventive work to reduce the frequency of alcohol consumption as a risk factor for infertility, especially among men of reproductive age.
Respondents are more likely to manifest neurotic depression, which in turn can manifest itself in
asthenic, phobic and anxious states, which are also accompanied by vegetative disorders.
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